Date Published: July 10, 2017
Publisher: Public Library of Science
Author(s): Ania Zubala, Stephen MacGillivray, Helen Frost, Thilo Kroll, Dawn A. Skelton, Anna Gavine, Nicola M. Gray, Madalina Toma, Jacqui Morris, Hajo Zeeb.
While there is strong evidence that regular participation in physical activity (PA) brings numerous health benefits to older adults, and interventions to effectively promote PA are being developed and tested, the characteristics and components of the most effective interventions remain unclear. This systematically conducted review of systematic reviews evaluated the effects and characteristics of PA promotion interventions aimed at community dwelling people over 50 years old.
Major databases were searched for reviews from January 1990 to May 2015. TIDieR guidelines aided data extraction and the ROBIS tool was used to assess the risk of bias. Primary outcomes were objective and self-reported levels of PA. Indicators of psychological wellbeing and participation rates were secondary outcomes.
Of 1284 records identified, 19 reviews met inclusion criteria and eight included meta-analyses. Interventions typically incorporated behaviour change techniques (BCTs) and were delivered as face-to-face, remote, group, individual or as combined interventions. Despite their heterogeneity, interventions often resulted in sustained improvements in PA over the study period, typically at 12 months, and led to improvements in general wellbeing. However, ways to ensure effective maintenance beyond one year are unclear. Certain intervention components were more clearly associated with positive effects (e.g. tailoring promotion strategy with combination of cognitive and behavioural elements, low to moderate intensity activity recommended). We found no evidence that certain other intervention characteristics were superior in achieving positive outcomes (e.g. mode of delivery, setting, professional background of the intervention provider, type of PA recommended).
The evidence suggests that interventions to promote PA among older adults are generally effective but there is uncertainty around the most beneficial intervention components. There are indications that purely cognitive strategies and BCTs might be less suitable for older adults than motivators more meaningful to them, including social and environmental support, and enjoyment coming from being physically active. A whole system-oriented approach is required that is tailored to meet the needs of older adults and aligned with social, individual and environmental factors.
There is considerable and consistent evidence that regular participation in physical activity (PA) has physical and mental health benefits for people of any age [1,2]. In older adults, evidence suggests that exercise reduces risk of cardiovascular disease, osteoporosis, some cancers, falls and cognitive decline [3,4]. Benefits of PA extend to maintaining people’s functional capacity and independence —outcomes particularly relevant to ageing population. There is also substantial evidence that engagement in PA has positive impacts reaching beyond physical health to improved mental wellbeing [6,7,8].
Due to heterogeneity in interventions, comparators and methodology of the included reviews, statistical pooling through meta-analysis was not appropriate. Although the findings of the current review are generally presented in a narrative format, we refer to meta-analyses performed by the included reviews’ authors, whenever available.
To our best knowledge, this is the first such extensive and comprehensive review of systematic reviews of PA promotion aimed at older adults and the first to report on both effectiveness and components of the most successful interventions, as well as on impacts of interventions on PA levels and psychological outcomes. Through our inclusive approach to PA promotion activities, which was not limited to only behavioural and cognitive strategies, we were able to highlight a range of factors that seem important to consider when designing programmes to improve PA among older adults.
The current review suggests that multi-modal and multi-component interventions have the potential to be effective at increasing physical activity of older adults living in the community. However, heterogeneity of interventions and a high chance of bias in the included reviews made it difficult to assess with certainty the precise magnitude of these effects. We were particularly interested in evidence of long-term effects, and the review demonstrates some positive and sustained effects of interventions on PA levels, self-efficacy and quality of life. Crucially, effects on maintenance beyond twelve months were unclear, due to a lack of high quality longitudinal studies, noted also in other reviews of PA promotion [23,55]. The generally positive effects we recorded were of small to moderate sizes, suggesting a potential impact at the population level, despite challenges in designing, implementing and researching interventions for large ageing populations. Our findings are in line with results reported by recent reviews of interventions to promote PA for adults  and those focusing on PA promotion in primary care [18,56] and contribute to a growing evidence that sustained PA participation of older adults may be successfully promoted.
The growing recognition of the importance of PA promotion for older adults is worth emphasising, as are the latest attempts to synthesise the emerging evidence. Astonishingly, a large majority of the papers included in this review (15 out of 19) were published in the last five years (after 2012). Two reviews of reviews on PA among older adults [22,23] have been published very recently, parts of which focus on PA promotion. Olanrewaju et al.  included 17 reviews, reporting on short term effects of both PA promotion and exercise and Bauman et al.  presented a brief synthesis of outcomes of 6 reviews. Both reviews were narrative and had a wider focus on PA among older adults, including the effects of exercise, with PA promotion explored as part of a larger investigation, and thus not as systematically examined as in the current review. An added value of our review is its focus on long term effects, assessment of psychological outcomes, inclusion of several new, key and high quality reviews (e.g. [30,34,42,43]), and the most comprehensive analysis of reviews focusing purely on interventions to promote PA and not exercise alone. Despite our and our colleagues’ efforts in synthesising the growing evidence, unanswered questions remain.
Despite challenges around summarising evidence from heterogeneous studies and reviews that generally presented high risk of bias, the current review confirms the effectiveness of multi-modal and multi-component interventions to promote physical activity for older adults. Although the effect sizes were small to moderate, interventions generally led to increased PA and to improvements in outcomes related to wellbeing. Mode of delivery, setting and profession of the intervention provider are not necessarily associated with effectiveness, but client-centred, personalised interventions which start with professional and tailored guidance and then provide ongoing support lead to improved participation in PA. Our review highlights the mixed results around the role of self-regulatory BCTs in PA promotion among older adults and advises further research to establish whether and how the potentially beneficial BCTs may be adapted to meet the needs of ageing populations. There are indications that purely cognitive strategies and BCTs requiring active planning might be less suitable for older adults than motivators more meaningful in their current lives, including social support, environmental factors and enjoyment coming from being physically active.